重度宫腔粘连分离术后预防再粘连的临床观察

目的 比较宫腔镜下行宫腔粘连分离术（transcervical resection of adhesions,TCRA）后放置节育环、反复宫腔镜检查不放置节育环对预防宫腔再粘连的疗效.方法 回顾性分析2010年1月至2012年10月江西省妇幼保健院生殖内分泌科收治的80例重度宫腔粘连患者的临床资料.均行TCRA,其中40例（对照组）术后宫腔内放置节育环,另40例（研究组）术后不放置节育环,进行反复宫腔镜检查.术后所有患者给予抗生素3.d,同时口服补佳乐4 mg,连用21 d,后5 d加用黄体酮胶囊200 mg,治疗3个疗程.观察术后宫腔恢复、月经改善及妊娠情况.结果 术后3个月,对照组和研究组术后宫腔再粘连率分别为47.5%和22.5%,月经改善率分别为65.0%和85.0%,妊娠率分别为30.0%和52.5%,2组比较差异均有统计学意义（均P＜0.05）.结论 重度宫腔粘连分离术后反复宫腔镜检查较术后上节育环更能有效预防宫腔再粘连,并可提高月经改善率及妊娠率.

Prevention of Re-adhesion Formation after Transcervical Resection of Severe Intrauterine Adhesions

Objective To compare the curative efficacies of intrauterine device insertion and re- peated hysteroscopy after transcervical resection of intrauterine adhesions （TCRA） in the preven- tion of intrauterine re-adhesion formation. Methods Clinical data of 80 patients with severe intra- uterine adhesions who underwent TCRA between January 2010 and October 2012 in the depart- ment of reproductive health of Jiangxi maternal and child health hospital were retrospectively ana- lyzed. Among the 80 patients,40 received intrauterine device insertion （control group）,and 40 re- ceived repeated hysteroscopy without intrauterine device insertion （study group）. After TCRA, all patients were treated with antibiotics for 3 days and oral estradiol valerate for 21 days. In addi- tion, patients were additionally given medroxyprogesterone （200 rag） during the last 5 days of the postoperative treatment. The restoration of intrauterine cavity,improvement in menses and preg- nancy rate were observed after 3 cycles of treatment. Results The incidence of intrauterine re-ad- hesion,improvement rate of menses and rate of pregnancy were,respectively,47.5% ,65.0% and 30.0% in control group,and 22.5% ,85.0% and 52.5% in study group. There were significant differences between the two group（P〈0.05）. Conclusion Repeated hysteroscopy is superior to intrauterine device insertion for preventing intrauterine re-adhesion and improving menses and pregnancy outcome after TCRA.